By Michael S. DeLaney, Esq., CELA
When someone is faced with the overwhelming job of finding a nursing home for a loved one, the question most often asked is, “Where do I begin?” Although this is a job that no one wants to do, it can be done with forethought and confidence that the best decision was made for everyone involved.
When nursing home placement is necessary, it is crucial that the family and/or potential resident decide what’s most important to them in looking for a facility. It is important the resident’s needs and wants be included in this evaluation. Things such as location of the facility, if a special care unit is necessary, and type of payer source should be considered when beginning this process.
If placement is “down the road” and you have time, call the nursing facilities and ask them to send you their information packet, including an activity calendar and a menu.
Get ready to tour the facilities you have chosen. Don’t schedule your tours. Just show up during regular business hours. You will be able to meet with the administrative staff who will answer all your questions. Next, you will want to tour a second time in the evening or on the weekend just to see if there is a drastic difference in the atmosphere of the facility or the care being provided. It is important to tour at least two facilities so you can see the difference in the physical plant and the staff.
When you are touring pay attention to your gut feeling. Ask yourself the following questions…Did I feel welcome? How long did I have to wait to meet with someone? Did the admission direction find out my family member’s wants and needs? Was the facility clean? Were there any strong odors? Was the staff friendly? Did they seem to generally care for the resident? Did the staff seem to get along with each other? Listen and observe. You can learn so much just by watching and paying attention.
When touring a facility, ask any questions that come to mind. There are no “dumb” questions. Here are a few examples of questions you will want to ask to make sure the administration of the facility is giving proactive care, rather than reacting to crisis:
- How do you ensure that call lights are answered promptly regardless of your staffing?
- If someone is not able to move or turn himself or herself, how do you ensure residents are turned and do not develop bedsores?
- How do you make sure that someone is assisted with the activities of daily living, like dressing, toileting, and transferring?
- Can residents bring in their own supplies?
- Can residents use any pharmacy?
- How many direct care staff members do you have on each shift? Does this number exceed the minimal number that state regulations say you have to have or do you just meet the minimum standard?
- What payer sources do you accept?
- How long has the medical director been with your facility?
- How were your last Department of Public Health survey results? (Ask to see a copy)
- How did you correct any deficiencies and what processes did you put in place to make sure you did not make these mistakes again?
- Has the state prohibited this facility from accepting new residents at any time during the last two years?
- What is your policy on family care planning conferences? Will you adjust your schedule to make sure that I can attend the meeting?
- Do you have any reference that I can talk with?
- Can my loved one come in for a meal to see if he or she fits in and likes the facility?
Use the Evaluation Form when touring facilities, so you can track how you rated each facility.
Once a facility has been chosen, there are some definite steps you can take to make the process less traumatic on the resident. First, plan the admission carefully. If you know the resident becomes very difficult to deal with in late afternoon, plan the admission for mid-morning. Next, complete the admission paperwork before your loved one moves into the facility; however, have your attorney review all admission paperwork prior to signing to protect your legal rights and to ensure a third party, such as a child, is not volunteering to pay the bill. Having the documentation in place will allow you to spend the first few hours with your loved one getting him or her settled and making your loved one feel secure in a new living environment.
Some practical things you can do…mark every piece of closing with a permanent laundry marker. When a facility is washing clothes for 100 people, or more, it is common for things to occasionally end up in the wrong room; however, you can help ensure getting the item back if it is properly marked. If you are going to do your loved one’s laundry yourself, post a sign on the closet door to notify staff and provide a laundry bag where dirty clothes can be placed. Also, bring in familiar things for your loved one to provide a feeling of home: photographs, books, knickknacks, and children’s drawings are always welcome.
A very important thing for you to remember is that the staff of the facility is just meeting your loved one for the first time. They do not know his or her likes or dislikes or those little nuances that make providing care go more smoothly. The best way you can help your loved one is to tell the staff, in writing, as much information about your loved one as possible, e.g., likes and dislikes, typical daily schedule, pet peeves, and so on.
It is important that you get to know the people who are caring for your loved one. While it is important to address any problems you recognize immediately, it is even more important to recognize good care when you see it. A simple complement or a small gift, such as a box of chocolates or a fast food gift card, can really make a health care providers day and encourage continued good care. Don’t forget to express your gratitude for their hard work and dedication.
Most importantly, stay involved. Let everyone know how much you care and how committed you are to your loved one’s care. Also, understand you will not help your loved one by becoming anxious or emotional. Assure them that although this is not an ideal situation, you will be there to assist them in making it as pleasurable as possible.
Nursing Home Evaluation
As you visit nursing homes, use the following form for each place you visit. Don’t expect every nursing home to score well on every question. The presence or absence of any of these items does not automatically mean a facility is good or bad. Each has its own strengths and weaknesses. Simply consider what is important to the resident and you.
Record your observations for each question by circling a number from one to five. (If this question is unimportant to you or doesn’t apply to your loved one, leave the evaluation area for that question blank.) Then, total all blanks you checked and divide by the number of blanks you completed. This will give you an average score for the facility.
Your ratings will help you compare nursing homes and choose the best one for your situation. But, don’t simply rely on the numbers. Ask to speak to family members of other residents. Also, for information about the nursing home, obtain a copy of the facility’s state inspection report from the nursing home, the Illinois Department of Public Health, or the Illinois Department on Aging Ombudsman. You may also consider purchasing for a small fee a detailed Nursing Home report at http://carescout.com. Also, http://medicare.gov/nhcompare offers at no charge three years of inspection reports covering numerous nursing homes.
Download Nursing Home Evaluation Form